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Old 10-17-2011
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Thyroid Feeling cold, Amenorrhea, and Puffy Eyes!

A 39-year-old woman comes to the office because she has not had a menstrual period for the past 2 months. Before that time she was having regular monthly menstrual cycles lasting 28 days with a 4-day menses. Lately she has been feeling unusually cold and has been experiencing “on and off” constipation. She has a history of migraines and had a laparoscopic left ovarian cystectomy 15 years ago. She is a divorced mother of a 10-year-old daughter and 8-year-old son. She works as a corporate lawyer and experiences a lot of stress. Physical examination shows puffy eyes, pale and dry skin, and diffuse alopecia. The remainder of the examination, including breast and pelvic examinations, is normal. Which of the following is the most appropriate next step in diagnosis?

A. Endometrial biopsy
B. Measurement of serum follicle-stimulating hormone level
C. Measurement of serum thyroid-stimulating hormone level
D. Measurement of urine human chorionic gonadotropin level
E. Pelvic computed tomography scan
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Old 10-17-2011
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even thogh she might be having a very early menopausal s/s
but first rule out preg
so uring bhcg
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Old 10-17-2011
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I think between D and c....dry skin, puffy eye, constipation, cold intolerance....so i think hypothyroidism...but any case of secondary amenorrhea always bhcg as pregnancy test first so answer is d.
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Old 10-17-2011
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Measurement of urine human chorionic gonadotropin level.
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Old 10-17-2011
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Post B

B. measurement of FSH ......
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Old 10-17-2011
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Correct Answer Answer

The correct answer is D. The most common cause of secondary amenorrhea in women of childbearing age is pregnancy. It is absolutely essential to remember this. Failure to keep the possibility of pregnancy in mind when evaluating a patient can lead to a failure to diagnose ectopic pregnancy or intrauterine pregnancy. Failure to diagnose these conditions can lead to significant maternal morbidity and mortality, fetal exposure to harmful medications or other exposures, and other poor outcomes.
Endometrial biopsy (choice A) would absolutely not be the most appropriate next step in diagnosis. Performing an endometrial biopsy without having a negative pregnancy test could lead to the inadvertent termination of a desired pregnancy. It is therefore essential to check a pregnancy test on this patient first.
Measurement of serum follicle-stimulating hormone level (choice B) is an appropriate step in the evaluation of amenorrhea. However, it is not the most appropriate next step in this case because the first step in the evaluation of secondary amenorrhea is to check a pregnancy test.
Measurement of serum thyroid-stimulating hormone level (choice C) is also an appropriate step in the evaluation of amenorrhea, inasmuch as hypothyroidism can lead to amenorrhea. However, although it is an appropriate step, it is not the most appropriate next step in this case.
Obtaining a pelvic computed tomography (CT) scan (choice E) is not the most appropriate next step in diagnosis. First, the appropriate next step here is a pregnancy test. Second, CT is not a part of the routine diagnostic workup for secondary amenorrhea.
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Old 04-09-2012
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TSH: Typical case of hypothroidism.
But pregnancy should be ruled out first...so Beta-hCG choice
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